When patients with hormonal breast tumors, more than 70% of cases, finish the treatment of surgery, chemotherapy and radiation therapy, they continue with hormone therapy, a new and complicated phase against long-term cancer. Doctors warn against the temptation to abandon this therapy: it reduces the risk of relapse and death.
On World Breast Cancer Day, the gynecologist Concha Sánchez, coordinator of the Breast Pathology Unit at the Ramón y Cajal University Hospital in Madridand the oncologist of this unit Noelia Martínez they send a message to these women to comply daily with hormone therapy, a treatment of at least five years, which can sometimes be extended to ten.
“It is a mandatory treatment that has demonstrated a survival benefit,” says Dr. Sánchez.
“It is important that they take this long-term treatment every day, it is a necessary race to reduce the chances of relapse” in cases of hormonal tumors, luminal A and B, points out Dr. Martínez.
The temptation to abandon hormone therapy
Vanessa Diaz, a 44-year-old designer, admits that she was once tempted to stop treatment. And her main motivation was to be able to get pregnant with a second child.
At the age of 35 she was diagnosed with a luminal tumor and, after conventional cancer treatment, came hormone therapy with tamoxifen, a drug that for decades has proven to keep hormonal activity at bay and is standard therapy for patients in premenopause
However, in the fifth year of treatment, when Vanesa was considering a new pregnancy, there was a relapse, another tumor appeared which led to the removal of the ovaries and, therefore, an early menopause and goodbye to one of his main life plans.
Now she is prescribed a new generation hormonal drug, the aromatase inhibitor, the prototype treatment for women with luminal tumors in the postmenopausal stage.
Despite the difficulties, Vanesa has not missed a single day of taking the hormone therapy: “I encourage all patients to continue, the treatment must be completed until the last day, as long as the oncologist does not discharge us we can make decisions for ourselves because we can take a fright”.
The side effects
And the main reason why some women are not regular in the treatment are the side effects: osteoarticular pains, suffocation, fatigue, vaginal dryness and atrophy, decreased libido, emotional instability and even alopecia.
Consequences that affect patients’ day-to-day life, their emotional, sexual, social, work life…
“I have to regulate the side effects, it mainly affects my emotions, everything is more extreme. Also at the beginning I had joint pains and I couldn’t climb the stairs well”, comments Vanessa, who resorted to exercise to be able to endure it.
Oncologist Noelia Martínez explains that these consequences of hormone therapy have gradually been resolved with first- and second-line painkillers.
“But the most important thing is that research has shown that physical exercise and the Mediterranean diet can improve and alleviate these side effects that deteriorate the quality of life so much,” points out the specialist, who recommends at least three times per week 45 minutes daily aerobic exercise.
Older women, more risk of abandonment
The coordinator of the Breast Pathology Unit at the Ramon i Cajal Hospital, gynecologist Concha Sánchez, emphasizes the importance of asking all patients at each check-up if they take the hormone therapy pill daily; to explain the consequences of leaving the medication; try to soften the side effects and evaluate changing the treatment to another of the same line if it is not tolerated.
“We cannot take for granted that all patients follow the treatment, there are some who stop taking it for a few weeks because it is difficult for them to live with pain and it affects their quality of life, they do not comply 100 percent”, he points out the doctor
Specialists note that older women are the most likely to skip hormone therapy.
“Each patient has their story behind them, many elderly women are caretakers of their husbands, of their families.
Young women, on the other hand, have more motivation to follow this long-term career: “They want to see their children grow up, they have a professional development, they want to live and they take hormone treatment, they fulfill it better”.
But younger patients, under the age of 40, don’t have it easy either. In addition to tamoxifen, in cases of greater risk, they are induced into menopause by removal of the ovaries or through an injectable drug that temporarily blocks ovarian activity.
In general, without this double hormonal blockade, tamoxifen can alter the rhythm of menstruation but does not eliminate it, so you need to take measures not to get pregnant during this hormonal treatment.
In cases of longer treatments, which exceed 5 years, studies point to situations in which tamoxifen can be temporarily suspended so that the patient fulfills her desire to become a mother.
Hormone therapy, an opportunity
Although it is a long-distance race with some obstacles, hormone therapy becomes an opportunity to survive and overcome luminal breast cancer.
It is true that after chemotherapy, radiotherapy and surgery, the purpose of which is to remove the tumor and the risk of relapse, a period of fear and stress, the woman faces this new phase of long-term treatment with prominent side effects: “It is what psychologically affects them the most”.
“But you have to tell them that with this fourth leg of the treatment they have a chance and they can respond. I advise them to, in some way, become friends with hormone therapy”, concludes the coordinator of the Breast Pathology Unit at Ramon i Cajal Hospital this World Day against Breast Cancer.